Therapeutic R2 resection for pleural mesothelioma

Our plain-English summary of Therapeutic R2 resection for pleural mesothelioma, by D. Nguyen, D.J. Sugarbaker, B.M. Burt (The Journal of Thoracic and Cardiovascular Surgery, 2018).

The study

• Authors: D. Nguyen, D.J. Sugarbaker, B.M. Burt
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2018;155(6):2734-2735
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This is an editorial commentary, not a new study. The authors, thoracic surgeons at Baylor College of Medicine in Houston, commented on a single-institution retrospective study by Batirel of resection-based treatment for malignant pleural mesothelioma (MPM). As the commentary described it, that study compared 75 patients who had macroscopic complete resection (MCR, removal of all visible tumor) with 57 who had partial resection. It found no difference in overall survival, a finding supported by a propensity-matched analysis. Matched MCR patients survived a median of 13.3 months, and 15% were alive at 5 years. The commentators noted that the groups differed in T stage, unexplored nodal status and adjuvant therapy, that matching left 23 patients per group, and that the study was underpowered. So a definitive link between completeness of resection and survival could not be established. Citing other work, they noted that local recurrence affects about three quarters of patients. The authors concluded that MCR, although an R1 resection, remains the objective of curative-intent surgery for MPM, and that the greatest unmet need is better control of micrometastatic disease.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Editorial commentary on another article (Batirel's single-institution retrospective study) in the same journal; no new data
• Who was studied: No patients of its own. The commented study (Batirel) compared 75 patients with malignant pleural mesothelioma who underwent macroscopic complete resection with 57 who underwent partial (incomplete) resection at a single institution
• Main results:
  • As reported in Batirel's study (not this commentary), there was no difference in overall survival between the 75 MCR patients and the 57 partial-resection patients, a finding supported by a propensity-matched analysis
  • In Batirel's study, propensity-matched patients undergoing MCR survived a median of 13.3 months, and 15% were alive at 5 years
  • The commentary cited the International Association for the Study of Lung Cancer Mesothelioma Database, in which 1493 patients undergoing curative-intent surgery had longer overall survival than 732 patients undergoing palliative procedures, including partial pleurectomy (a different dataset, not this commentary's own finding)
  • Citing other work, the authors stated that local recurrence affects approximately three quarters of patients with surgically treated MPM
• The authors' conclusion: The authors concluded that macroscopic complete resection in MPM, although an R1 resection because it cannot eliminate microscopic disease, remains the objective of curative-intent surgery. They also concluded that the greatest unmet need is better local and systemic control of micrometastatic disease.
• Limitations the authors state:
  • The commentators noted that in Batirel's study the MCR and non-MCR groups were disproportionate with respect to T stage, unexplored nodal status and receipt of adjuvant therapy, and that propensity matching left only 23 patients per group
  • Batirel's study was underpowered: 355 subjects would have been needed to show a 10% difference in overall survival between MCR and non-MCR cohorts, so a definitive relationship between completeness of resection and survival could not be established
  • The authors noted that the datasets supporting MCR are each retrospective and limited

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

Related studies

• Clinical indications and results after chest wall resection for recurrent mesothelioma — B.M. Burt, S.O. Ali, et al. (2013)
• Soluble Mesothelin-Related Peptides to Monitor Recurrence After Resection of Pleural Mesothelioma — B.M. Burt, H.S. Lee, et al. (2017)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• Prevalence of in vitro chemotherapeutic drug resistance in primary malignant pleural mesothelioma: result in a cohort of 203 resection specimens — A.A. Mujoomdar, T.R. Tilleman, et al. (2010)
• CD8+ tumor-infiltrating lymphocytes predict favorable prognosis in malignant pleural mesothelioma after resection — N. Yamada, S. Oizumi, et al. (2010)
• Improving surgical resection rate in lung cancer — C. Laroche, F. Wells, et al. (1998)

Browse more research in The Journal of Thoracic and Cardiovascular Surgery, or return to medical research.